Dr. Roboz on Improving the Standard Treatment of AML

Gail J. Roboz, MD, associate professor of medicine, director of the Leukemia Program at the Weill Medical College of Cornell University and the New York-Presbyterian Hospital in New York City, explains research into potential improvements to the standard treatment of acute myeloid leukemia (AML).

The standard AML treatment (7 + 3) is seven days of cytarabine continuous intravenous infusion, three days of an anthracycline intravenous push, and usually chemotherapy. Randomized trials have shown the addition of cladribine or gemtuzumab ozogamicin to the 7 + 3 regimen have shown improvements in overall survival. Roboz says that while gemtuzumab ozogamicin is not currently available, it could be a possible addition to the standard treatment of AML, in the future.

Older drugs are also being transformed into more precisely targeted formulations for AML. Elacytarabine uses a fatty acid to get more of the drug, cytarabine, into cells. CPX-351 is a 5:1 molar ratio liposomal formulation of cytarabine and daunorubicin, another drug used to treat hematologic malignancies. Vosaroxin, a novel topoisomerase II inhibitor, damages DNA at selective sites and causes cell death by apoptosis.

These new drugs are in development and are based on the idea that cytarabine and anthracyclines are the best drugs for AML but can be optimized to hit leukemic cells and continue circulation without being overly metabolized.